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septoplasty-111003152845-phpapp01 (1).pptx

  1.       Define septoplasty and related terms. Understand patient’s history and diagnosis. Review the anatomy of nose. Discuss the disease condition. Describe related nursing interventions. Identify the health education given to the patient.
  2. ⚫ ⚫ ⚫ ⚫ Deviated- to turn aside from a regular course Cartilage- a tough elastic connective tissue Nasal septum- partition between two nasal cavities Incision- the act of cutting
  3. By:Shuroq Safori
  4. ⚫ Septoplasty - a surgical procedure to correct the shape of the deviated septum of the nose. ⚫ It is done to correct defects or deformities of the septum. ⚫ It is performed to correct obstructions related to the nasal septum.
  5.  -Nasal airway obstruction - Can lead to mouth breathing, chronic nasal infection, or obstructive sleep apnea.      Nasal septal deformity Headaches caused by septal spurs Chronic and uncontrolled nosebleeds Chronic sinusitis associated with a deviated septum Tumor excision
  6. ⦿ The goal of septoplasty is to improve breathing through the nose and also to prevent sinus infections. ⦿ The procedure usually involves an excision of a portion of the cartilage and bone. ⦿ An incision is made in the lining of the septum to reach the cartilage. ⦿ The septum may then be stabilized with small plastic tubes, splints or nasal packs to prevent bleeding.
  7. ⦿ Nasal Septum - a partition dividing between 2 nasal cavities ⦿ Sinuses- - It secretes mucus fluid that usually drains into the nose
  8. by: Sherly Reji
  9. On 10th August 2009 at 1400H, a 26 y/o female Saudi patient admitted from ENT out patient department with known case of Deviated Septum. Scheduled for Septoplasty on 11th August 2009 at 0900H under DR. Hossam.
  10. L.O.C. Heart - Alert, oriented, ambulatory, on room air - Normal heart sound Abdomen - soft, lax, non-tender , + bowel sounds Admission and surgical consent signed by father. As per protocol, DVT form, general history and physical assessment filled by admitting physician
  11. Patient complained of nasal obstruction since there was no improvement with medical treatment, so advised for surgical treatment
  12. Routine admission procedure done. Fall Risk assessment form completed. Baseline V/S checked: BP Pulse Rate Respiration Temp. O2 saturation Weight Height 117/70mmHg 80bpm 20breaths/min 37degrees centigrade 98% on room air 103kg 165cm
  13. CBC : Hgb Hct Plt RBC 13.6 g/dL 39.9 % 232 K/dL 4.73 M/uL NORMAL VALUE 12.0- 18.0 g/dL 37.0- 51.0 % 140- 440 K/dL 4.20- 6.30 M/uL Coagulation profile: 10.7- 12.1 sec 32.6- 37.6 sec PT PTT INR 11.6 sec 34.8 sec 1.0 Blood chemistry was done also. All within normal range.
  14.  On 10th August 2009 Evening shift: ⚫ Consent for surgery checked and confirmed. ⚫ Routine evening care done. ⚫ Anesthesia evaluation done at 2100h, with pre- anesthesia checklist completed.
  15. ⚫ Patient was instructed Nothing Per Orem after 12 midnight as ordered. Re-assured. ⚫ IV cannula G22 inserted on Rt Metacarpal vein at 0530H. NPO re-iterated. ⚫ IV fluid D5 Water 500ml hooked and regulated at 100ml/hr rate at 0600H.
  16.  On 11th August 2009 Day shift: ⦿ ⦿ Injection Zantac 50mg IV and Premosan 10 mg IV given at 0830h. NPO maintained.
  17. ⦿ Pre-op V/S checked and recorded. ⦿ ⦿ Pre-operative checklist as per protocol checked, done and completed. Patient reassured and to Operating room on call for septoplasty.
  18. ⦿ ⦿ ⦿ ⦿ Patient was propped in reclined position. V/S checked as per protocol. Patient was instructed not to blow in the nose. Dressing was assessed for further bleeding.
  19. ⦿ Sips of water served and when tolerated, normal diet served. ⦿ ⦿ Pain assessed and analgesic given as prescribed. Kept rested with siderails up in comfortable position.
  20. ⦿ Nasal pack was removed by ENT surgeon on 12th August 2009 at 0800H. ⦿ Dressing was changed and noted for further bleeding. ⦿ ⦿ Tolerated normal diet. Discharged at 1400H with discharge and home meds instructions given.
  21. By: Sindhu Philip
  22. DRUG NAME DOSE & ROUTE INDICATION ADVERSE REAC TION I nj. Z antac 50 mg IV stat -Duodenal ulcer, gastric ulcer including that associated with non- steroidal anti- inflammatory agents - post- operative ulcer -Diarrhea and other gastro- intestinal disturbances, altered liver function tests, headache, dizziness, rash I njPrimperan 10mg IV stat Nausea and vomiting, dyspeptic manifestation due to a digestive mobility disorder Extrapyramidal reactions, drowsiness, vertigo, dizziness, headache, depression, GI disturbances and HTN
  23. DRUG NAME DOSE & ROUTE INDICATION ADVERSE REACTION Tab Klacid 500mg BD per orem Treatment of infections: -Lower respiratory tract infection - Upper respiratory tract infection - Nausea, headache,, dyspepsia, diarrhea, vomiting, abdominal pain and paresthesia Tab Sapofen 400mg BD per orem Anti- inflammatory and analgesic effects. - To relive pain in post- operative cases - Gastrointestinal disturbances, skin rash, nervousness, headache, tinnitus. POST-OP MEDIC INE
  24. DRUG NAME DOSE & ROUTE INDICATION ADVERSE REACTION Tab Sapofen 400mg BD per orem Anti- inflammatory and analgesic effects. - To relive pain in post- operative cases - Gastrointestinal disturbances, skin rash, nervousness, headache, tinnitus. POST-OP MEDIC INE
  25. by: Ednaly Santiago
  26. NURSING DIAGNOSIS ASSESSMENT GOAL INTERVENTION RATIONALE EVALUATION Fear and anxiety r/ t upcoming invasive procedure S - “ Ana fi kouf sister”as verbalized by patient. O- uneasy feeling, facial expression Patient will be able to control and reduce the level of fear and anxiety pre and post operatively -Clear and concise explanation was given regarding procedure . - Encouraged patient to verbalize feelings and reassured. -To lessen patient’s fear -Patient verbalized that she understoo d the procedure. - Patient verbalized she feels better and calm.
  27. NURSING DIAGNOSIS ASSESSMENT GOAL INTERVENTION RATIONALE EVALUATION POST-OP: Alteration in comfort; pain r/t post septoplas ty S- “ Ahlam sister” as claimed by patient. O- slght swelling noted over patient’s nose To promote comfort by minimizing pain. -Post-op V/S monitored according to protocol. -Analgesic administered as prescribed. To monitor level of pain and lessen pain Patient verbalized relief and minimal tolerable pain.
  28. NURSING DIAGNOSIS ASSESSMENT GOAL INTERVENTION RATIONALE EVALUATION Potential for bleeding r/t post- op procedure S- “ Fi dam etla” O- nasal dressing was minimally soaked with blood - To minimize and prevent further bleeding on the operated site -Patient’s head was kept elevated and rested in reclined position. - Dressing checked every now and then for further bleeding. Head elevation reduces further bleeding and swelling . No further bleeding or swelling noted. Bleeding and swelling minimized.
  29. By: Shuroq Safori
  30.  Septoplasty can occasionally lead to a few minor complications like: ⦿ ⦿ ⦿ ⦿ ⦿ ⦿ Bleeding Infection Septal perforation Nasal deformity Adhesions Numbness of upper front teeth
  31.  Patient was instructed and taught: ⦿ ⦿ ⦿ ⦿ ⦿ To expect blood stained/ pinkish discharge for a few days That she will be breathing through mouth until swelling is gone. Not to hit or move any part of the nose. Not to hold back a sneeze. Sneeze with the mouth open. To expect a crusting in the nose for not more than 6 weeks while the incision is healing.
  32. ⦿ She can eat and drink normally although soft diet are best. ⦿ To avoid all moderate and heavy physical activity, including sport for ten days after the operation and avoid bending. ⦿ ⦿ ⦿ Avoid smoky, dusty and dry atmospheres. If develops a temperature and increasing nasal / facial pain a few days after the operation, to consult doctor. Improvement in nasal breathing may take a few weeks.